type name label

start start
end end
today today
deviceid deviceid
subscriberid subscriberid
simserial sim_serial

select_one district district District:

select_one health_facility health_facility Catchment Area / Health Facility:
text village What is the name of the Village you are in?
select_one yes_no sprayable_structure Is this a sprayable structure?
select_one structure non_spray_structure_type What is this structure?
geopoint non_spray_structure_gps GPS location of structure:
geopoint structure_gps GPS location of structure:
text structure_head_name Head of Household (Structure) name
text irs_sticker_num IRS Sticker Structure #

begin group sprayed Sprayed

select_one yes_no was_sprayed Was this Structure Sprayed?
select_one bottle bottles How many bottles were used to refill the can at this structure?
integer male_population Male Population
integer female_population Female Population
calculate total_pop
acknowledge total_pop_note Total Population is: ${total_pop}. Please tick if this is correct.
integer pregnant_women Pregnant Women
integer children_u5 Children < 5 years
begin group eligible_rooms Eligible Rooms
integer rooms_total Total Rooms Found in the House
integer rooms_eligible Number of ELIGIBLE Rooms Found in the House
integer rooms_sprayed Number of Rooms Sprayed
end group
begin group mosquito_nets Mosquito Nets
integer total_nets Total Number of Nets Hanging and in Use
integer sprayed_total_uNet Total Number of Residents Sleeping Under Nets
integer sprayed_pregwomen_uNet Number of Pregnant Women Sleeping Under Net
integer sprayed_u5_uNet Number of Children < 5 Yrs Sleeping Under Net
end group
end group

begin group unsprayed Unsprayed

select_one reason reason Reason for not spraying?
text hh_phone_number Please provide the head of household contact number.
integer unsprayed_male_population Male Population
integer unsprayed_female_population Female Population
calculate unsprayed_total_pop
acknowledge unsprayed_total_pop_note Total Population: ${unsprayed_total_pop}. Please tick if this is
integer unsprayed_pregnant_women Pregnant Women
integer unsprayed_children_u5 Children < 5 years
begin group unsprayed_mosquito_nets Mosquito nets
integer unsprayed_total_nets Total Number of Nets Hanging and in Use
integer unsprayed_total_uNet Total Number of Residents Sleeping Under Nets
integer unsprayed_pregwomen_uNet Number of Pregnant Women Sleeping Under Net
integer unsprayed_u5_uNet Number of Children < 5 Yrs Sleeping Under Net
end group
end group
 choice_filter hint relevant

district=${district}
Please double-check your spelling!

selected(${sprayable_structure},'no')
selected(${sprayable_structure},'no')
selected(${sprayable_structure},'yes')
selected(${sprayable_structure},'yes')
selected(${sprayable_structure},'yes')

selected(${sprayable_structure},'yes')

efill the can at this structure? selected(${was_sprayed},'yes')

selected(${was_sprayed},'yes')
selected(${was_sprayed},'yes')
selected(${was_sprayed},'yes')
Please tick if this is correct. selected(${was_sprayed},'yes')
selected(${was_sprayed},'yes')
selected(${was_sprayed},'yes')
selected(${was_sprayed},'yes')

d in the House

selected(${was_sprayed},'yes')

ng Under Nets ${total_nets}>0

eping Under Net ${total_nets}>0
ng Under Net ${total_nets}>0

selected(${was_sprayed},'no')

hold contact number. Enter the head of household cont selected(${reason},'Refused')

tal_pop}. Please tick if this is correct.

 selected(${was_sprayed},'no')

ng Under Nets ${unsprayed_total_nets}>0

eping Under Net ${unsprayed_total_nets}>0
ng Under Net ${unsprayed_total_nets}>0
 calculation appearance constraint

ucture},'no')
ucture},'no')
ucture},'yes')
ucture},'yes')
ucture},'yes') numbers regex(.,'^[:digit:]{6}$')

ucture},'yes')

. >= 0 and . < 20

. >= 0 and . < 20
${male_population} + ${female_population}

. >= 0 and .<= ${female_popula

. >= 0 and .< ${total_pop}

. > 0 and . < 20

. > 0 and . <= ${rooms_total}
. > 0 and . <= ${rooms_eligible}

. >= 0 and .<= ${total_pop}

. >= 0 and .<= ${total_pop} and
. >= 0 and .<= ${pregnant_wom
. >= 0 and .<= ${children_u5}

numbers regex(.,'^[:digit:]{10}$')
. >= 0 and . < 20
. >= 0 and . < 20
${unsprayed_male_population} + ${unsprayed_female_population}

. >= 0 and .<= ${unsprayed_fe

. >= 0 and .< ${unsprayed_tota
. >= 0 and .<= ${unsprayed_tot
. >= 0 and .<= ${unsprayed_tot
. >= 0 and .<= ${unsprayed_pr
. >= 0 and .<= ${unsprayed_ch
constraint_message required

yes
yes
yes
yes
yes
yes
yes
yes
Must be 6 digits yes

yes
yes
yes
Must be less than 20 yes
Must be less than 20 yes
yes
yes
Must be equal to or less than yes
Must be less than Total Populatyes
yes
Must be less than 20 yes
Must be equal to or less than yes
Must be equal to or less than yes

yes
Must be equal to or less than T yes
Must be equal to or less than T yes
Must be equal to or less than yes
Must be equal to or less than Cyes

yes
Must be 10 numbers
Must be less than 20
Must be less than 20

Must be equal to or less than Female Population

Must be less than Total Population
Must be equal to or less than Total Population
Must be equal to or less than Total Population AND equal to or more than Total Nets in Use
Must be equal to or less than Pregnant Women or Total Population
Must be equal to or less than Children < 5 Years or Total Population Sleeping Under Nets
list name name label district
district 1 Chienge
district 2 Nchelenge
district 3 Kawambwa

health_facility 8 Chipungu RHC 1

health_facility 20 Kabwe RHC 1
health_facility 22 Kalembwe RHC 1
health_facility 44 Mukunta RHC 1
health_facility 55 Mwabu RHC 1
health_facility 59 Sambula RHC 1
health_facility 3 Chabilikila RHC 2
health_facility 14 Kabalenga RHC 2
health_facility 19 Kabuta RHC 2
health_facility 24 Kambwali RHC 2
health_facility 26 Kapambwe HP 2
health_facility 28 Kashikishi HAHC 2
health_facility 46 Mulwe HP 2
health_facility 57 Nchelenge RHC 2
health_facility 4 Chama RHC 3
health_facility 5 Chibote RHC 3
health_facility 7 Chimpempe RHC 3
health_facility 11 Chitondo RHC 3
health_facility 15 Kabanda RHC 3
health_facility 17 Kabila RHC 3
health_facility 30 Kawambwa HAHC 3
health_facility 32 KTC RHC 3
health_facility 47 Munkanta RHC 3
health_facility 50 Mushota Zonal RHC 3
health_facility 54 Muyembe RHC 3

structure kitchen Kitchen

structure animal_shelter Animal Shelter
structure food_storage Food Storage
structure school School
structure lodge Lodge
structure shop Shop
structure office Office
structure hospital_clinic Hospital or Clinic
structure other Other

yes_no yes Yes

yes_no no No
male_female male Male
male_female female Female

reason sick Sick

reason locked Locked
reason funeral Funeral
reason refused Refused
reason noone_home_missedNo one home / Missed
reason other Other

bottle 0 0
bottle 1 1
bottle 2 2
title form_id
Structure Survey on Malaria Spraying spraying_survey
instance_name
concat('Eligible. ' , ${sprayable_structure} , 'Spray Form. ' , ${start} , ' Sprayed, ' , ${was_sprayed}, ' - Reason, ', $
{reason}, ' - Name, ' , ${structure_head_name})